NPIMap

Organization Active NPI

Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Longmont, CO
National Provider Identifier
1154937282
Registry record updated Jun 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
POUDRE VALLEY MEDICAL GROUP, LLC
Practice address
2900 Peak Ave
Longmont, CO 80504-6236
Phone
(720) 652-4468
Fax
(720) 718-8999
NPI assigned
Sep 23, 2020
Organization subpart
Yes
Parent organization
POUDRE VALLEY MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jana Conroy
Title
Director of Credentialing
Phone
(720) 652-4468

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

2900 Peak Ave
Longmont, CO 80504-6236

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071
Phone (720) 652-4468

Other names 2

  • UCHealth Medical Group Doing business as
  • UCHealth Employer Health Clinic - Smuckers Other name

National Provider Directory

National Provider Directory
Tax ID family
Poudre Valley Medical LLC282 organizations share this tax ID, including this one
Part of
Poudre Valley Medical LLC

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2900 Peak Ave
Longmont, CO 80504
Phone (720) 652-4468

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1154937282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "720-652-4468",
            "fax_number": "720-718-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 PEAK AVE",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805046236",
            "telephone_number": "720-652-4468",
            "fax_number": "720-718-8999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "enumeration_date": "2020-09-23",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "CONROY",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "720-652-4468"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCHealth Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UCHealth Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UCHealth Employer Health Clinic - Smuckers",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Longmont, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.